º£½ÇÉçÇø

º£½ÇÉçÇø — LOS ANGELES (Feb. 6, 2025) -- When life gets bleak for Destany Epps-Manuel, 36, she knows the only way to go is forward.

That’s what she’s been doing since she was 22, when she was diagnosed with dilated cardiomyopathy, a rare disease that causes the heart muscle to weaken and, eventually, stop pumping blood.

After college graduation, Epps-Manuel began her career in special education. She grew up with a brother with special needs, and Epps-Manuel believed she had found her calling. But one day in 2010, during her first job as a teaching assistant, she came home feeling like she had just run a marathon. She couldn’t catch her breath. An emergency physician discovered her heart was enlarged, and the next day, a cardiologist diagnosed Epps-Manuel with dilated cardiomyopathy.

Just three years earlier, the former intramural college volleyball player had given birth to a healthy boy, and she had never had health issues. No one in her family was known to have a heart condition.

Epps-Manuel’s type of dilated cardiomyopathy is idiopathic, meaning the cause is unknown.

“It was very hard mentally,” she said. “I started having issues with palpitations and had to start wearing an external defibrillator. It was just one thing after another.”

To give herself more flexibility, Epps-Manuel left her elementary school job, moved in with her parents and started a ministry and service center for people with cognitive disabilities.

A few years after she was diagnosed, surgeons at Baylor University Medical Center in Texas implanted a left ventricular assist device (LVAD) to help Epps-Manuel’s heart pump blood. Less than two years later, she received a second LVAD after the first one caused a major blood clot in the cannula of the device’s pump.

In December 2014, Epps-Manuel received a long-awaited heart transplant in Texas, which was followed by difficulties. Medications she took to keep her body from rejecting her new heart so severely injured a kidney that she had to undergo a kidney transplant in 2022. Ten years after the heart transplant, her heart also started to fail. That’s when her Texas doctors referred her to the Smidt Heart Institute at Cedars-Sinai. , assistant professor of Cardiac Surgery, led the team of physicians, nurses and operating room staff who performed the transplant.

“When I first met Destany in April 2024 she was very sick, but she was physically fit and had a lot of life ahead of her,” Gunn said.

Epps-Manuel’s case pushed the limits of what surgeons can do.

“With each additional redo surgery, different parts of the heart, tissues and bone fuse together and it becomes much more technically challenging to operate,” Gunn said. “These surgical considerations are why centers from across the nation refer their most difficult cases to Cedars-Sinai.”

Although Epps-Manuel has spent much of her adult life facing life-or-death situations, waiting for her second heart transplant made her feel especially hopeless. She credits the support program led by , director of Consultation Liaison Services in the Department of Psychiatry and Behavioral Neurosciences, with helping her through her sickest period. The program taught her coping tactics such as meditation and helped her use virtual reality to calm her mind. 

“You have to feel your feelings, but you can't stay there,” she said. “You have to have a mindset to fight.”

Epps-Manuel’s second heart transplant took place in October 2024 during a nine-hour operation at the Smidt Heart Institute. A life-support machine called cardiopulmonary bypass temporarily did the work of Epps-Manuel’s heart and lungs. It took surgeons two hours to carefully dissect the bands of scar tissue around the old heart and remove it, a process that typically takes 30 minutes.

Another challenge the Smidt Heart Institute faced was that Epps-Manuel had developed antibodies to the first transplant, so there was a high risk that any future donor heart would be quickly rejected.

, director of the Heart Transplant Program at Cedars-Sinai and a world expert in preventing and treating organ rejection, managed Epps-Manuel’s care pre- and post-transplant. He created an aggressive immunotherapy plan to stop her body from rejecting the new heart.

Epps-Manuel and her mother lived in Los Angeles for months while she waited for her transplant and recovered afterward. She missed being able to tour colleges with her son, but she is now healthy enough to travel back and forth between her home in Cedar Hill, Texas, and Cedars-Sinai, where she continues to receive desensitization therapy for donor antibodies. She’s excited to volunteer with her ministry again and watch her son compete in senior-year football and track.

“Destany has an incredible, upbeat attitude, which contributes to her recovery,” Kobashigawa said. “She is a joy to care for and continues to inspire our collective team.”

Read more on the Cedars-Sinai Blog--